The word vertigo is defined as a sense of spinning, either of the world spinning about you, or you are spinning internally. Many times, this word is incorrectly used interchangeably with dizziness or light-headedness. Vertigo is, in and of itself, not a true diagnosis of anything, it just means that a patient has a symptom of spinning – getting to the root cause of why the spinning occurs is typically the best way to solve the problem.
First and foremost, anyone who experiences a sense of spinning vertigo for the first time should immediately seek evaluation from their General Practitioner or local Emergency Room. Spinning, or any other symptoms such as dizziness, light-headedness, or imbalance that comes on suddenly may be coming from a pathology in the inner ear system (vestibular system), but there is also a possibility these symptoms are coming from a more sinister origin – such as a brain or heart problem. Evidence generally suggests that vestibular symptoms that have distinct and reproducible triggers are more commonly benign (and coming from the ear); whereas more dangerous symptoms commonly occur spontaneously (without triggers such as head movement).
Furthermore, a thorough examination of the patient’s eye movements can be very helpful in determining an underlying cause of symptoms. The type of nystagmus (which is an involuntary twitching or jerking movement of the eyes) can be very strongly correlated with whether the problem is arising from your ears or something else. This sounds odd, but one of the primary functions of the inner ear is to sense movement of the head and to help in maintaining clear vision during head movements. Therefore, dysfunction in the vestibular system can manifest itself as abnormal eye movements (nystagmus). Typically, more dangerous brain problems can also manifest themselves through the eyes, but with a distinct pattern of nystagmus that differentiates it from a more benign inner ear disorder. There are also certain clinical bedside tests that a properly trained practitioner can perform to help determine the true source of your vertigo.
Once any non-vestibular sources of symptoms are cleared, it then becomes important to determine exactly what the problem in the inner ear is. The inner ear is actually made up of 5 motion sensory organs and a cochlea for hearing, and any one of these six structures, or various combinations may be creating your symptoms. Problems that affect the inner ear can be as varied as infections, debris particles, autoimmune disorders etc. – all of which might require specific and different treatments. Typically, focusing in on the timing and triggers of vestibular symptoms is much more helpful to the diagnosis than focusing on the quality of symptoms. What this means is that it is less important whether the symptoms are described as true vertigo, dizziness, faintness etc.; rather, more importantly, we need to know if the symptoms are constant versus episodic; how long each episode lasts; and are there movements or specific triggers to the symptoms.
Vestibular disorders can be quite challenging and confusing to manage. Symptoms that can affect one individual may vary widely in degree, type, severity and frequency from another. If you are ever unfortunate enough to experience vertigo, or any other symptoms of an inner ear disorder, make sure you keep a clear record of the exact nature of your symptoms so that you can accurately provide a history to your treating Physician or treating Practitioner. This will go a long way in helping them to come to a quick and accurate diagnosis, and hopefully to get you on the road to recovery as soon as possible.
Crowson, M. Decoding the Symptomatology of Vestibular Disorders. VEDA Newsletter “On the Level” Spring 2017.
Newman-Toker, D.E. (2012). Symptoms and signs of neuro-otologic disorders. Continuum Lifelong Learning in Neurology, 18(5), 1016-1040.